A Novel Discharge Medication Process: A Needs Assessment

Bedside medication delivery programs involve delivering discharge medications to hospitalized patients before discharge. These programs have significantly reduced 30-day hospital readmissions and emergency department visits (Prusaczyk, Mixon, & Kripalani, 2020). Bedside medication delivery programs also increase the number of patients who obtain medications by removing barriers commonly associated with obtaining prescriptions, including cost and transportation. Intermountain Medical Center (IMC) discontinued its medication delivery service in August 2021. Local Problem: Since the discontinuation of bedside medication delivery, providers now send electronic prescriptions to the patient's preferred outpatient pharmacy. Patients are then expected to obtain their medications after discharge. This process change has led to increased post- discharge patient phone calls to the unit regarding medication questions and an increase in the charge nurse (CN) workload. Methods: A needs assessment was performed at IMC on CVU3 and CVU4 to help identify a new medication discharge process within the CV Hospitalist (CVH) service. IMC is an urban, level 1 trauma center that serves the Salt Lake Valley. CVU3 and CVU4 are two 28-bed units that service a variety of cardiovascular patients. Interventions: A strengths, weaknesses, opportunities, and threats (SWOT) analysis was conducted to assess current needs. A survey was sent to CNs on CVU3 and CVU4 to examine their satisfaction with the new medication delivery process, how the change has affected their workflow, and common patient concerns they encountered. Readmission data was collected to assess if discontinuation of bedside medication delivery services increased 30-day readmission rates. Data was analyzed and categorized using descriptive statistics. Results were presented to the CVH and their nurse coordinators to develop a new medication discharge process based on evidence and analysis of the current medication discharge process. An executive summary was presented to CVU leadership with proposed plans for intervention implementation. Results: Readmission data was collected between 2018 and 2019 before bedside medication delivery services were discontinued and between 2021 and 2023, the timeframe after the program's discontinuation. The year 2020 was omitted due to the COVID-19 pandemic. Between 2018 and 2019, 8061 patients were discharged. Of those, 935 were readmitted within 30 days. Between 2021 and 2023, 8242 patients were discharged, and 925 patients were readmitted in 30 days. CN survey results demonstrated dissatisfaction with the current medication discharge process. Three major patient concerns emerged, including medication unavailability at the outpatient pharmacy, the outpatient pharmacy being closed, and educational concerns. Data was presented to CVH and their RN coordinators, and a new discharge process was developed. The new process was proposed to CVU leadership for future implementation. Conclusion: This needs assessment developed a new medication discharge process with buy-in from the CVH and their nursing coordinators. Further quality improvement projects could examine the implementation of this new process to determine its sustainability, benefits to patients, and satisfaction of CNs.

1 A Novel Discharge Medication Process: A Needs Assessment Lauren M. McCreath Alesa Hobson and Sara Hart College of Nursing: The University of Utah NURS 7703: DNP Scholarly Project III March 31, 2024 2 Abstract Background: Bedside medication delivery programs involve delivering discharge medications to hospitalized patients before discharge. These programs have significantly reduced 30-day hospital readmissions and emergency department visits (Prusaczyk, Mixon, & Kripalani, 2020). Bedside medication delivery programs also increase the number of patients who obtain medications by removing barriers commonly associated with obtaining prescriptions, including cost and transportation. Intermountain Medical Center (IMC) discontinued its medication delivery service in August 2021. Local Problem: Since the discontinuation of bedside medication delivery, providers now send electronic prescriptions to the patient’s preferred outpatient pharmacy. Patients are then expected to obtain their medications after discharge. This process change has led to increased postdischarge patient phone calls to the unit regarding medication questions and an increase in the charge nurse (CN) workload. Methods: A needs assessment was performed at IMC on CVU3 and CVU4 to help identify a new medication discharge process within the CV Hospitalist (CVH) service. IMC is an urban, level 1 trauma center that serves the Salt Lake Valley. CVU3 and CVU4 are two 28-bed units that service a variety of cardiovascular patients. Interventions: A strengths, weaknesses, opportunities, and threats (SWOT) analysis was conducted to assess current needs. A survey was sent to CNs on CVU3 and CVU4 to examine their satisfaction with the new medication delivery process, how the change has affected their workflow, and common patient concerns they encountered. Readmission data was collected to assess if discontinuation of bedside medication delivery services increased 30-day readmission rates. Data was analyzed and categorized using descriptive statistics. Results were presented to 3 the CVH and their nurse coordinators to develop a new medication discharge process based on evidence and analysis of the current medication discharge process. An executive summary was presented to CVU leadership with proposed plans for intervention implementation. Results: Readmission data was collected between 2018 and 2019 before bedside medication delivery services were discontinued and between 2021 and 2023, the timeframe after the program's discontinuation. The year 2020 was omitted due to the COVID-19 pandemic. Between 2018 and 2019, 8061 patients were discharged. Of those, 935 were readmitted within 30 days. Between 2021 and 2023, 8242 patients were discharged, and 925 patients were readmitted in 30 days. CN survey results demonstrated dissatisfaction with the current medication discharge process. Three major patient concerns emerged, including medication unavailability at the outpatient pharmacy, the outpatient pharmacy being closed, and educational concerns. Data was presented to CVH and their RN coordinators, and a new discharge process was developed. The new process was proposed to CVU leadership for future implementation. Conclusion: This needs assessment developed a new medication discharge process with buy-in from the CVH and their nursing coordinators. Further quality improvement projects could examine the implementation of this new process to determine its sustainability, benefits to patients, and satisfaction of CNs. Keywords: bedside medication delivery, patient concerns, charge nurse, CV hospitalist 4 A Novel Discharge Medication Process: A Needs Assessment Problem Description Hospital readmissions are a major burden to healthcare systems and individuals. Approximately 20% of Medicare beneficiaries will experience a planned or unplanned hospital readmission within 30 days after discharge (El Morabet, Uitvlugt, Van Den Bemt, Janssen, & Karapinar-Çarkit, 2018). Unplanned readmissions have an estimated annual cost of $17 billion in the United States (El Morabet, Uitvlugt, Van Den Bemt, Janssen, & Karapinar-Çarkit, 2018). Previous studies have shown that approximately 20% of hospital readmissions can be medication-related and close to 70% of those are possibly preventable (Glans, Kragh Ekstam, Jakobsson, Bondesson, & Midlöv, 2021). To combat this, bedside medication delivery programs were developed to improve patient’s transition from hospital to home. These programs have been associated with reducing 30-day hospital readmissions and emergency department visits (Prusaczyk, Mixon, & Kripalani, 2020). In addition, bedside medication delivery can remove common barriers related to obtaining medication outpatient, including payment and transportation. By delivering medications to the bedside, the healthcare team can assist with any issues and encourage patients to participate in their care. IMC is an urban, level 1 trauma hospital that serves the Salt Lake Valley. In August of 2021, IMC closed all 25 retail community pharmacies, including the outpatient pharmacy located on IMC’s campus. Without an outpatient pharmacy, IMC discontinued its bedside medication delivery service. In its place, patients are expected to obtain prescriptions at a preferred outpatient pharmacy after discharge. This process change has led to increased patient phone calls to the unit after discharge with questions regarding medications and has impacted CN workflow. 5 Available Knowledge Medication nonadherence is a prevalent problem and is associated with adverse outcomes, including hospital readmission. As the United States population starts to age, medication nonadherence is likely to grow as patients take increasing numbers of medications to treat chronic conditions. To improve medication adherence and prevent hospital readmission, bedside medication delivery services were implemented across many healthcare systems. Bedside medication delivery services have been shown to reduce hospital readmissions and improve patient satisfaction in several studies (Prusaczyk, Mixon, & Kripalani, 2020; Comer, Goldsack, Flaherty, Van Velzen, … Corbo, 2017). The risk of readmission increases in patients who are 65 years or older, those with polypharmacy, and for patients who have medication dosages adjusted during hospitalization (Glans, Kragh Ekstam, Jakobsson, Bondesson, & Midlöv, 2020; Kirkham, Clark, Paynter, Lewis, & Duncan, 2014; Kripalani, Price, Vigil, & Epstein, 2008). Conflicting data suggests bedside medication delivery services do not reduce 30-day readmission risk. Several studies indicate that bedside delivery may have favorable effects when bundled with other care transition activities. However, it is unlikely to affect readmission rates as an isolated intervention (Conliffe, VanOpdorp, Weant, & VanArsdale, 2019; Lam, & Sokn, 2019; Segal, Apfel, Brotman, Shermock, & Clark, 2020). Rationale Discharging patients from the hospital to the outpatient setting is a complex process and can be complicated (Bullock, Morecroft, Mullen, & Ewing, 2017). Medication discrepancies after hospital discharge can cause unnecessary harm and stress to patients and can result in readmission to the hospital. Since the discontinuation of bedside delivery services at IMC, it is 6 important to determine how problems arise and where a discharge process change can be implemented. The Johns Hopkins Evidence-Based Practice Model (JHEBP) was chosen to guide this needs assessment. JHEBP is a three-phase model referred to as the PET process: practice question, evidence, and translation. In the practice question phase, the quality improvement team identifies the patient population, interventions, and outcomes (PICO). In the second phase, a literature review is conducted to understand and appraise the current evidence. The final phase synthesizes findings to identify and develop practice changes. The PET process within the JHEBP ensures that the latest research and best practices can be quickly incorporated into patient care. The JHEBP model is used in this needs assessment to address the current practice gap that was left when the medication bedside delivery service was discontinued. This framework can help elucidate a new medication discharge process providing sustainable, long-lasting outcomes. Specific Aims This Doctor of Nursing (DNP) scholarly project aimed to identify a new medication discharge process within the CVH group at IMC by conducting a needs assessment. The specific aims are to 1) assess the current medication discharge process, including trends in hospital readmission rates and healthcare provider satisfaction, 2) evaluate the current medication discharge process concerning the effects on patients, providers, and the system, 3) develop a new discharge process that is based on evidence and analysis of the current medication discharge process, and 4) provide stakeholders with recommendations and guidance for a new medication discharge process. 7 Methods Context CVU3 and CVU4 at IMC is a combined 56-bed unit that manages a wide range of cardiovascular patients. IMC is a large, urban, non-profit, level-one trauma center located in the central region of the Salt Lake Valley. IMC serves a large population of patients within the Intermountain West region. Many patients admitted to CVU3 and CVU4 are managed by the inpatient CVH service. The CVH team comprises of 10 physicians and 3 physician assistants (PA). The team also employs nursing coordinators who work in close conjunction with providers. The CVH team is led by an elected physician and coordinator within their group. In addition, CVU3 and CVU4 employ approximately 88 registered nurses (RNs). Patients admitted to CVU3 and CVU4 are of various ages, ethnicities, cultures, and socioeconomic backgrounds. The patient population is often older (>65) with multiple co-morbid conditions. They have complex medical conditions that require an array of medication management. The previously available bedside medication delivery service allowed patients time with the pharmacist to ask questions and obtain important medication education. In addition, patients from CVU3 and CVU4 come from various socioeconomic backgrounds. Often, persons of lower socioeconomic status are unable to afford medications and will be discharged from the hospital and will not pick up their prescribed medications. This leaves them vulnerable to hospital readmission. Bedside medication delivery services helped ease this burden by addressing this concern before hospital discharge. This service is no longer available. Intervention(s) The current discharge medication process was evaluated to assess the current practice gap. In the project’s first phase, a survey was sent to nursing staff about the medication discharge process to identify staff satisfaction and concerns, readiness to change, and perceived barriers to 8 change. The topics of patient concerns were collected when patients called with concerns regarding medications after discharge. A secure Excel spreadsheet was placed on the charge nurse’s (CN's) computer, and it was requested that the CN input patient concerns when they called the unit. Three data points were entered at the end of the collection period. To capture more data regarding common patient concerns, a question was added to the CN survey asking them to recall patient concerns and estimate how long they were on the phone. Patient concerns were identified and categorized from survey data. Finally, retrospective data was collected regarding readmission rates before and after the discontinuation of the bedside medication service. In phase two, the data obtained was analyzed using simple descriptive statistics. This was used to determine common medication concerns after discharge and healthcare professionals' satisfaction with the current process. In phase three, data was compiled into a short presentation for the CVH group. A comprehensive review of the current process was presented to CVH coordinators, and recommendations for a new process were proposed. Recommendations for a new discharge process change were developed. This was completed through two meetings with the CVH group. Data was brought to the CVH team, and interventions were tailored to common patient concerns. The discharge process proposed to providers and coordinators was modified to incorporate feedback. Finally, formal recommendations were presented to CVU leadership and management after the CVH coordinator review and buy-in. Finalized discharge process changes were presented to stakeholders to assess satisfaction and usability of proposed process changes. Stakeholders included RN leadership and nurse managers for CVU3 and CVU4. 9 Study of the Interventions This needs assessment project aimed at identifying a new medication discharge process that would have buy-in from CVH, nursing coordinators, and CVU leadership. This project’s scope did not include implementing a change in the current discharge process. However, retrospective readmission data, surveys to staff, and stakeholder responses were studied to identify and design a new discharge process that had buy-in from key partners. Measures A strengths, weakness, opportunities, and threats (SWOT) analysis was conducted to assess CVU3 and CVU4’s current position with the medication discharge process and plan for future process changes (Appendix A). A survey (Appendix B) was used to assess the nursing staff’s current knowledge, satisfaction with the medication discharge process, and perceived barriers to a new discharge process. The survey consisted of seven questions using the Likert scale and open-ended questions. To determine if readmission rates changed significantly after the discontinuation of medication bedside delivery, readmission data for CVU3 and CVU4 was collected through weekly meetings with MDClone staff. MDClone is a self-service tool that allows IMC caregivers to access and query Intermountain data to gain insights into patientrelated questions. Readmission data was collected for two points in time and then compared. Readmission data was collected between 2018 and 2019 before bedside medication delivery services were discontinued and between 2021 and 2023, the timeframe after the program's discontinuation. The year 2020 was omitted due to the COVID-19 pandemic. Readmission data focused on all inpatients discharged from either CVU3 or CVU4. An Excel spreadsheet was placed on the CN-shared computer to document common patient concerns regarding filling prescriptions after discharge (Appendix C). The spreadsheet 10 was left for data input from September to January. Patient concerns when calling the hospital were collected and categorized. Feedback from the CVH coordinator review was collected via notetaking from an in-person interview to ensure the proposal was feasible and satisfactory. Analysis Descriptive statistics were used to analyze nursing surveys. Patient concerns were collected and categorized using an open-ended question. Pre- and post-readmission data were compared using a Chi-squared test. Feedback from CVH was reviewed via email correspondence to develop recommendations. Ethical Considerations No conflicts of interest were noted in this project. According to the University of Utah and IMC, this project was considered quality improvement and was not subject to Institutional Review Board (IRB) oversight. Results The CN staff survey are summarized in Table 1 and Figure 1. Of the respondents, 82.4% (n=4) did not agree that the current medication discharge process is effective, while 17.6% (n=3) were neutral. Of the respondents, 94.2% (n=16) did not believe the current process was convenient for patients, while 5.9% (n=1) were neutral. All respondents (n=17) reported that the current discharge process did not improve their workflow and make discharge encounters easier. All respondents (n=17) reported an observed increase in patient phone calls to the floor with concerns about filling their prescriptions. Finally, CNs were asked to estimate how long they spent on the phone with discharged patients. Of the respondents, 23.5% spent 0-15 minutes per phone call, 47.1% spent 16-30 minutes per phone call, 23.5% spent 31-45 minutes per phone call, and 5.9% spent 46-60 minutes per phone call. 11 Common patient concerns were categorized in Table 2. Data collection revealed that 64.7% of CNs have had a patient report that their pharmacy did not carry their prescribed medication. Second, 52.9% of CNs reported receiving a phone call stating that the patient’s pharmacy was closed. Finally, 23.5% of CNs reported that patients called with educational concerns regarding their medications. Between 2018 and 2019, 8061 patients were discharged from CVU3 and CVU4. Of those 8061 patients, 935 were readmitted within 30 days. Between 2021 and 2023, 8242 patients were discharged, and 925 patients were readmitted in 30 days. Pre- and post-readmission data were compared using a Chi-squared test, and the results were not statistically significant (p=0.4217). The results of the data analysis and meetings with CVH leadership produced three possible medication discharge process changes. The first recommendation is the addition of a second swing shift MD and/or coordinator to help off-load afternoon admissions and provide more availability to nursing staff to address post-discharge patient concerns. The second proposed change requests that the CVH coordinators follow up with outpatient pharmacies to ensure that prescriptions have been received and the medication can be filled that day. The third change proposes that the CNs would be given access to the CVH coordinator messaging system. This would require the CN to record patient concerns and send patient information to the CVH coordinator after hours. The CVH coordinator will follow up with the patient the following day to resolve the issue. Discussion Summary This project’s first and second aims were to assess and analyze the current medication discharge process on CVU3 and CVU4. This was conducted via a survey of CNs to evaluated their satisfaction with the current discharge process, collection of patient concerns, and 12 retrospective readmission rates. Survey results demonstrate that CNs are dissatisfied with the current medication discharge process. Survey results also indicate that most CNs believe that the current medication discharge process is ineffective for bedside nurses, inconvenient for patients, and does not improve workflow. In addition, phone calls from patients who have been discharged have increased since the discontinuation of bedside medication delivery services at IMC. CNs are spending 15-45 minutes on the phone troubleshooting medication concerns. Three major themes emerged from patient concerns when calling the unit. One, patients discharged late or on weekends/holidays have difficulty obtaining their medications as their preferred pharmacy is closed. Two, pharmacies may not carry their medications. And finally, the patients called with questions. Readmission data was obtained before and after bedside medication delivery services were discontinued. Readmissions did not increase after the discontinuation of bedside medication delivery services. The third aim of this project was to present a comprehensive review of the current process to the CVH and their nursing coordinator to develop a new discharge process. Three possible medication discharge process changes were identified through two formal meetings with CVH and their coordinators. Interventions were tailored to common patient concerns and if the new process would be usable for CNs. The fourth aim of this project was to present recommendations to CVU leadership. All three potential interventions were proposed and brought to CVU leadership for discussion and implementation. Interpretation Data reviewed from the readmission query did not show an increase in patient readmission after the discontinuation of bedside medication delivery services. The lack of increase after the discontinuation of the program could be due to appropriate triage of patient 13 concerns by the CNs. The lack of a bedside medication delivery service has significantly strained the nursing staff. Results of the CN survey indicate that CNs are dissatisfied with the current medication discharge process. They are increasingly being taken away from their roles on the floor, and CNs are spending more time on the phone with patients who are no longer inpatients. Phone calls remove them from the floor and shift their attention to persons who are no longer under their direct care. Results from the CN survey also indicated that patients had difficulty obtaining their outpatient prescriptions due to pharmacies not stocking particular medications. Cardiac medications are critical, and missed doses are not recommended. Patients unable to obtain their prescriptions put them at increased risk for harm. Meetings with the CVH team indicated dissatisfaction within the provider group as well with the current medication discharge process and a willingness to change. Discussions with the CVH team proposed targeted interventions based on results from this needs assessment. Further quality improvement projects are warranted to implement the suggested propositions. Limitations This project had several limitations. Data was only obtained from one hospital and one provider group, limiting the generalizability of the project results for other specialties and hospitals within IMC. In addition, process changes were developed with only one provider group. Therefore, process improvements may not be able to be applied to other provider groups that discharge patients from CVU3 or CVU4. Furthermore, data collection regarding patient concerns was retrospective and may be prone to recall bias. Finally, data collected regarding readmission rates could not identify patients with medication non-adherence as the driving factor 14 for readmission. Patients were included in the data set if readmitting diagnosis was the same as their prior admission. Conclusions Results of this quality improvement project show that readmissions did not increase when the bedside medication delivery service was discontinued. However, CNs are dissatisfied with the current medication discharge process and believe it has negatively impacted their patients and increased their workload. Discussions between CVH coordinators and CVU leadership demonstrated buy-in and established infrastructure that could allow for a new medication discharge process. Further projects could examine the implementation of this new medication discharge process to determine its sustainability, benefits to patients, and satisfaction of CNs. If the new medication discharge process is sustainable and feasible, it could serve as a guide for other internal medicine providers within the Intermountain Health system. 15 Acknowledgments I would like to thank Sara Hart, PhD, RN for her guidance with this project. I would like to thank Dr. Dylan Werst and Laurie Mills, BSN for their willingness to meet with me and adopt a new process change. Thank you to Alesa Hobson and Ashley White of CVU for their encouragement. Finally, my thanks to all CNs on CVU3 and CVU4 for taking the time to participate in this project. 16 References Bullock, S., Morecroft, C.W., Mullen, R., & Ewing, A.B. (2017). Hospital patient discharge process: an evaluation. European Journal of Hospital Pharmacy, 24(5), 278–282. https://doi.org/10.1136/ejhpharm-2016-000928. Comer, D., Goldsack, J., Flaherty, J., Van Velzen, K., Caplan, R., Britt, K., Viohl, H., Heitz, K., & Corbo, T. (2017). Impact of a discharge prescription program on hospital readmissions and patient satisfaction. Journal of the American Pharmacists Association, 57(4), 498– 502.e1. https://doi.org/10.1016/j.japh.2017.04.007. Conliffe, B., VanOpdorp, J., Weant, K., VanArsdale, V., Wiedmar, J., & Morgan, J. (2019). Impact of an advanced pharmacy practice experience student-run “meds 2 beds” and discharge counseling program on quality of care. Hospital Pharmacy, 54(5), 314-322. https://doi.org/10.1177/0018578718791519. El Morabet, N., Uitvlugt, E.B., Van Den Bemt, B.J.F., Van Den Bemt, P.M.L.A., Janssen, M.J.A., & Karapinar-Çarkit, F. (2018). Prevalence and preventability of drug-related hospital readmissions: A systematic review. Journal of the American Geriatrics Society, 66(3), 602–608. https://doi.org/10.1111/jgs.15244. Glans, M., Kragh Ekstam, A., Jakobsson, U., Bondesson, Å., & Midlöv, P. (2020). Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01867-3. Glans, M., Kragh Ekstam, A., Jakobsson, U., Bondesson, Å., & Midlöv, P. (2021). Medicationrelated hospital readmissions within 30 days of discharge—A retrospective study of risk factors in older adults. PLOS ONE, 16(6), e0253024. https://doi.org/10.1371/journal.pone.0253024. 17 Jones, V., Zelnicek, T., Hines, M. T., Johnson, E. J., O’Neal, K. S., & Draugalis, J. R. (2022). Creation and implementation of a pharmacy-led meds-to-beds program at a large teaching hospital. Journal of the American Pharmacists Association, 62(3), 870–876. https://doi.org/10.1016/j.japh.2021.11.020. Kirkham, H.S., Clark, B.L., Paynter, J., Lewis, G.H., & Duncan, I. (2014). The effect of a collaborative pharmacist-hospital care transition program on the likelihood of 30-day readmission. American Journal of Health-System Pharmacy, 71(9), 739-745. https://doi.org/10.2146/ajhp130457. Kripalani, S., Price, M., Vigil, V., & Epstein, K.R. (2008). Frequency and predictors of prescription‐related issues after hospital discharge. Journal of Hospital Medicine, 3(1), 12–19. https://doi.org/10.1002/jhm.248. Lam, S.W., & Sokn, E. (2019). Effect of pharmacy driven bedside discharge medication delivery program on day 30 hospital readmission. Journal of Pharmacy Practice, 33(5), 628-632. https://doi.org/10.1177/0897190019825. Prusaczyk, B., Mixon, A.S., & Kripalani, S. (2020). Implementation and sustainability of a pharmacy-led, hospital-wide bedside medication delivery program: A qualitative process evaluation using RE-AIM. Frontiers in Public Health, 7. https://doi.org/10.3389/fpubh.2019.00419. Segal, J. B., Apfel, A., Brotman, D.J., Shermock, K.M., & Clark, J.M. (2020). Evaluation of bedside delivery of medications before discharge: Effect on 30-Day readmission. Journal of Managed Care & Specialty Pharmacy, 26(3), 296–304. https://doi.org/10.18553/jmcp.2020.26.3.296. 18 Tables and Figures Table 1 Charge Nurse Medication Discharge Process Survey Results Survey Questions From my experience, the new medication discharge process is effective. From my experience, the new medication discharge process is convenient for patients. From my experience, the new pharmacy discharge process has improved my workflow and made discharge encounters easier. Survey Question Since the implementation of the new medication discharge process, there has been an increase in Strongly Agree Agree Results N (%) Neutral 0 (0) 0 (0) 3 (17.6) 8 (47.1) 6 (35.3) 0 (0) 0 (0) 1 (5.9) 8 (47.1) 8 (47.1) 0 (0) 0 (0) 0 (0) 8 (47.1) 9 (52.9) Disagree Strongly Disagree Results True False 17 (100) 0 (0) 19 patient phone calls to the floor with concerns about filling their prescriptions. 20 Figure 1 Time Charge Nurse Spends on the Phone with Discharged Patients Regarding Medications 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 0-15 minutes 16-30 minutes 31-45 minutes 46-60 minutes 21 Figure 2 Common Patient Concerns with Discharge Medications 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Medication not available at pharmacy Pharmacy is closed Cost Educational concerns Other 22 Appendix A SWOT Analysis 23 Appendix B Charge Nurse Survey 24 Appendix C Patient Concerns Excel Spreadsheet 25 Appendix D Executive Summary A Novel Discharge Medication Process: A Needs Assessment EXECUTIVE SUMMARY Situation Bedside medication delivery programs involve delivering discharge medications to hospitalized patients before discharge. These programs have significantly reduced 30-day hospital readmissions and emergency department visits (Prusaczyk, Mixon, & Kripalani, 2020). Bedside medication delivery programs also increase the number of patients who obtain medications by removing barriers commonly associated with obtaining prescriptions, including cost and transportation. Intermountain Medical Center (IMC) discontinued its medication delivery service in August 2021. Background Since the discontinuation of bedside medication delivery, providers now send electronic prescriptions to the patient’s preferred outpatient pharmacy. Patients are expected to obtain their medications after discharge. This process change has led to increased post-discharge patient phone calls to the unit regarding medication questions and an increase in the charge nurse (CN) workload. Assessment • • • Readmission rates did not increase after the bedside medication delivery service was discontinued. CNs are overwhelmingly dissatisfied with the current medication discharge process. Patients calling the unit after discharge with questions about medications have increased, and common concerns have been categorized below. Common Patient Concerns with Discharge Medications 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Medication Pharmacy is not available closed at pharmacy Cost Educational concerns Other 26 Recommendations This needs assessment provided necessary data for CVU leadership and CVH to implement a novel medication discharge process. Further quality improvement projects could examine the implementation of a new medication discharge process to determine its sustainability, benefits to patients, and satisfaction of CNs.